| NPI | 1962043240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE J TELFORD Managed Care Consultant 469-800-8648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2020-12-29 |